Mutations in the COCH (coagulation factor C homology) gene have been attributed to DFNA9 (deafness, autosomal-dominant 9), an autosomal-dominant non-syndromic hearing loss disorder. However, the mechanisms responsible for DFNA9 hearing loss remain unknown. Here, we demonstrate that mutant cochlin, the protein product of the COCH gene, forms a stable dimer that is sensitive to reducing agent. In contrast, wild-type (WT) cochlin may form only dimers transiently. Interestingly, the presence of mutant cochlin can stabilize WT cochlin in dimer conformation, providing a possible mechanism for the dominant nature of DFNA9 mutations. Furthermore, the expression of mutant cochlin eventually induces WT cochlin to form stable oligomers that are resistant to reducing agent. Finally, we show that mutant cochlin is cytotoxic in vitro and in vivo. Our study suggests a possible molecular mechanism underlying DFNA9 hearing loss and provides an in vitro model that may be used to explore protein-misfolding diseases in general.Protein misfolding is a fundamental mechanism underlying multiple chronic neurodegenerative diseases, including Alzheimer disease, Huntington disease, and prion disease, which have been called collectively the conformational diseases to emphasize the role of aberrant protein conformations in the clinical manifestation of the diseases (1). Mutations of different genes involved in these diseases have been shown to lead to oligomerization and aggregation of corresponding proteins to form amyloid. The conformational transition that leads to the formation of amyloid requires misfolding of native protein structure and intermolecular bonding. However, we still understand very little about the conformational transition processes from the misfolded state to the aggregated state, as this transition for most conformational disease-associated mutant proteins explored so far is both rapid and heterogeneous.Point mutations in the COCH (coagulation factor C homology) gene are responsible for an autosomal-dominant non-syndromic hearing disorder termed DFNA9 (deafness, autosomaldominant 9) (2). DFNA9 is characterized by adult-onset, progressive neurosensory hearing loss with vestibular dysfunction. Pathological studies of the temporal bones from affected individuals have shown remarkable degeneration of neuroepithelial cells, including both fibrocytes and neurosensory cells, and the accumulation of abundant acellular eosinophilic deposits throughout the auditory and vestibular systems (3, 4). However, the mechanism responsible for the degeneration and hearing loss in DFNA9 syndrome remains unknown.The amino acid sequence of cochlin, the protein product of the gene COCH, is highly conserved in mammals (5). The deduced amino acid sequence of cochlin contains a signal peptide in its N terminus, followed by a region homologous to a domain in the FCL domain (factor C of Limulus; also named the LCCL domain for Limulus factor C/Coch-5b2/Lgl1), a short intervening domain, and two von Willebrand factor A-like domains separated by a se...